Esophagitis

Esophagitis (uh-sof-uh-JIE-tis) is inflammation that may damage tissues of the esophagus, the muscular tube that delivers food from your mouth to your stomach.

Esophagitis can cause painful, difficult swallowing and chest pain. Causes of esophagitis include stomach acids backing up into the esophagus, infection, oral medications and allergies.

Treatments for esophagitis depend on the underlying cause and the severity of tissue damage. If left untreated, esophagitis can damage the lining, interfere with normal function and lead to complications such as scarring, stricture and difficulty swallowing.

Esophagitis is generally categorized by the conditions that cause it. In some cases, more than one factor may be causing esophagitis.

Reflux esophagitis

A valve-like structure called the lower esophageal sphincter usually keeps the acidic contents of the stomach out of the esophagus. If this valve opens when it shouldn't or doesn't close properly, the contents of the stomach may back up into the esophagus (gastroesophageal reflux). Gastroesophageal reflux disease (GERD) is a condition in which this backflow of acid is a frequent or ongoing problem. A complication of GERD is chronic inflammation and tissue damage in the esophagus.

Eosinophilic esophagitis

Eosinophils (e-o-SIN-o-fils) are white blood cells that play a key role in allergic reactions. Eosinophilic esophagitis occurs with a high concentration of these white blood cells in the esophagus, most likely in response to an allergy-causing agent (allergen) or acid reflux or both.

In many cases, people who have this kind of esophagitis are allergic to one or more foods. Some foods that may cause eosinophilic esophagitis include milk, eggs, wheat, soy, peanuts, beans, rye and beef. However, conventional allergy testing does not reliably identify these culprit foods.

People with eosinophilic esophagitis may have other nonfood allergies. For example, inhaled allergens, such as pollen, may be the cause in some cases.

Drug-induced esophagitis

Several oral medications may cause tissue damage if they remain in contact with the lining of the esophagus for too long. For example, if you swallow a pill with little or no water, the pill itself or residue from the pill may remain in the esophagus. Drugs that have been linked to esophagitis include:

Bisphosphonates, including alendronate (Fosamax), a treatment for weak and brittle bones (osteoporosis)

Quinidine, which is used to treat heart problems

Infectious esophagitis

A bacterial, viral or fungal infection in tissues of the esophagus may cause esophagitis . Infectious esophagitis is relatively rare and occurs most often in people with poor immune system function, such as people with HIV/AIDS or cancer.

A fungus normally present in the mouth called Candida albicans is a common cause of infectious esophagitis. Such infections are often associated with poor immune system function, diabetes, cancer and antibiotic use.

Eosinophilic esophagitis

Risk factors for eosinophilic esophagitis, or allergy-related esophagitis, may include:

A history of certain allergic reactions, including allergic rhinitis, asthma and atopic dermatitis

A family history of eosinophilic esophagitis

Drug-induced esophagitis

Factors that may increase the risk of drug-induced esophagitis are generally related to issues that prevent quick and complete passage of a pill into the stomach. These factors include:

Swallowing a pill with little or no water

Taking drugs while lying down

Taking drugs right before sleep, probably due in part to the production of less saliva and swallowing less during sleep

Older age, possibly because of age-related changes to the muscles of the esophagus or a decreased production of saliva

Large or oddly shaped pills

Infectious esophagitis

Risk factors for infectious esophagitis often relate to medications, such as steroids and antibiotics. People with diabetes also are at increased risk of candida esophagitis in particular.

Other causes of infectious esophagitis may relate to poor immune system function. This may be due to an immune disorder, HIV/AIDS or certain cancers. Also, certain cancer treatments and drugs that block immune system reactions to transplanted organs (immunosuppressants) may increase the risk of infectious esophagitis.

If you're experiencing severe chest pain that lasts more than a few minutes or if you suspect you have food lodged in your esophagus or are unable to swallow, get emergency medical care.

If you have other signs or symptoms of esophagitis, you'll likely start by seeing your primary care doctor. For some diagnostic tests, your doctor may refer you to a specialist in digestive system disorders (gastroenterologist) or an allergy specialist (allergist). Preparing for your appointment with your doctor or a specialist will help you make the best use of your time.

What you can do

Make a list ahead of time that you can share with your doctor. Your list should include:

Symptoms you're experiencing, including any that may seem unrelated to pain, difficulty swallowing or reflux

Key personal information, including any major stresses or recent life changes

Medications that you're taking, including vitamins and other supplements

Family history of allergies and disorders of the esophagus or stomach

Questions to ask your doctor

List questions for your doctor from most important to least important in case time runs out. If you think you have signs or symptoms of esophagitis, you may ask some of the following questions.

What tests will I need to diagnose the condition?

Do these tests require any special preparation?

How long will it take to find out the results of tests?

What treatments are available, and which do you recommend?

How will we know if the treatment is working?

Will I need follow-up tests?

What steps can I take on my own to prevent a recurrence of the symptoms?

I have other medical conditions. How can I best manage these conditions together?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:

How severe is your pain or discomfort?

Do you have difficulty swallowing?

How often do you experience symptoms?

Does anything seem to prompt or worsen symptoms, such as certain foods?

Does anything lessen symptoms, such as taking over-the-counter antacids or avoiding certain foods?

Are symptoms worse at certain times of the day?

Do your symptoms begin shortly after taking any medications? If so, which medications?

Do you have any allergies, and do you take any allergy medication?

Have you ever had food get stuck in your throat after swallowing?

Do you ever have food come back up after swallowing?

Do you have a family history of gastrointestinal problems?

What you can do in the meantime

If you know that certain foods trigger or worsen symptoms, avoid them. Common culprits include caffeine-containing drinks, alcohol or spicy foods. Taking over-the-counter antacids may provide short-term relief of symptoms.

If you suspect that your symptoms are related to a prescription medication, don't stop taking the drug without first talking to your doctor. If possible, limit the use of over-the-counter medications that could be causing problems. When you take pills, drink a glass of water and avoid lying down immediately afterward.

Your doctor or specialist will likely make a diagnosis based on your answers to questions, a physical exam, and one or more tests. These tests may include:

Barium X-ray

For this test, you drink a solution containing a compound called barium or take a pill coated with barium. Barium coats the lining of the esophagus and stomach and it makes the organs visible. These images can help identify narrowing of the esophagus, other structural changes, a hiatal hernia, tumors or other abnormalities that could be causing symptoms.

Endoscopy

Doctors guide a long, thin tube equipped with a tiny camera (endoscope) down your throat and into the esophagus. Using this instrument, your doctor can look for any unusual appearance of the esophagus and remove small tissue samples for testing. The esophagus may look different depending on the cause of inflammation, such as drug-induced or reflux esophagitis. You'll be lightly sedated during this test.

Laboratory tests

Small tissue samples removed (biopsy) during an endoscopic exam are sent to the lab for testing. Depending on the suspected cause of the disorder, tests may be used to:

Eosinophilic esophagitis

Treatments for esophagitis are intended to lessen symptoms, manage complications and treat underlying causes of the disorder. Treatment strategies vary primarily based on the cause of the disorder.

Reflux esophagitis

Treatment for reflux esophagitis may include:

Over-the-counter treatments. These include antacids (Maalox, Mylanta, others); medications that reduce acid production, called H-2-receptor blockers, such as cimetidine (Tagamet HB) and ranitidine (Zantac); and medications that block acid production and heal the esophagus, called proton pump inhibitors, such as lansoprazole (Prevacid) and omeprazole (Prilosec).

Baclofen is a medication that may decrease the frequency of relaxations of the lower esophageal sphincter and therefore decrease gastroesophageal reflux.

Surgery. Fundoplication may be used to improve the condition of the esophagus if other interventions don't work. A portion of the stomach is wrapped around the valve separating the esophagus and stomach (lower esophageal sphincter). This strengthens the sphincter and prevents acid from backing up into the esophagus.

The Linx, a newer device approved by the Food and Drug Administration, is a ring of tiny magnetic titanium beads. It is wrapped around the junction of the stomach and esophagus to strengthen the lower esophageal sphincter. The Linx can be implanted using minimally invasive surgery methods.

Eosinophilic esophagitis

Treatment for eosinophilic esophagitis is primarily avoiding the allergen and reducing the allergic reaction with medications. Medications may include:

Topical swallowed steroids. Inhaled steroids act topically in the airway and are used to manage asthma. Some studies have shown that swallowed steroids may similarly act topically in the esophagus and help treat eosinophilic esophagitis.

Your doctor will instruct you on how to swallow the steroid preparation so that it coats your esophagus. This delivery system of steroids is much less likely to cause serious side effects than taking oral steroid pills.

6-food elimination diet. A response to a food allergen is likely the cause of eosinophilic esophagitis. Therefore, elimination of the culprit food may be an effective treatment strategy.

However, as no tests are currently available to identify the culprit food, your doctor may recommend that you remove common food allergens from your diet. Under your doctor's direction, you'll gradually add foods back into your diet and note when symptoms return.

Drug-induced esophagitis

Treatment for drug-induced esophagitis is primarily avoiding the problem drug when possible and reducing the risk with better pill-taking habits. Your doctor may recommend:

Taking an alternative drug that is less likely to cause drug-induced esophagitis

Taking a liquid version of a medication if possible

Drinking an entire glass of water with a pill, unless you've been told by your doctor to restrict your fluid intake because of another condition, such as kidney disease

Depending on the type of esophagitis you have, you may lessen symptoms or avoid recurring problems by following these steps:

Avoid foods that may increase reflux. Avoid eating excessive amounts of foods that you know worsen your symptoms of gastroesophageal reflux. These may include alcohol, caffeine, chocolate and mint-flavored foods.

Use good pill-taking habits. Always take a pill with plenty of water. Don't lie down for at least 30 minutes after taking a pill.

Lose weight. Talk to your doctor about an appropriate diet and exercise routine to help you lose weight and maintain a healthy weight.

If you smoke, quit. Talk to your doctor if you need help ending a smoking habit.

Avoid certain medications. Avoid some pain relievers and antibiotics, as well as some other medications, if you have an enlarged left upper heart chamber (atrium) or after heart surgery.

Avoid stooping or bending, especially soon after eating.

Avoid lying down after eating. Wait at least three hours after eating to lie down or go to bed.

Raise the head of your bed. Place wooden blocks under your bed to elevate your head. Aim for an elevation of 6 to 8 inches (15 to 20 centimeters). Raising your head by using only pillows isn't effective.

No alternative medicine therapies have been proved to treat esophagitis. Still, some complementary and alternative therapies may provide some relief from heartburn or reflux symptoms when combined with your doctor's care. Talk to your doctor about what alternative treatments may be safe for you. Options may include:

Herbal remedies. Herbal remedies sometimes used for heartburn or reflux symptoms include licorice, slippery elm, chamomile, marshmallow and others. Herbal remedies can have serious side effects, and they may interfere with medications. Ask your doctor about a safe dosage before beginning any herbal remedy.

Relaxation therapies. Techniques to calm stress and anxiety may reduce signs and symptoms of heartburn or reflux. Ask your doctor about relaxation techniques, such as progressive muscle relaxation or guided imagery.

Acupuncture. Acupuncture involves inserting thin needles into specific points on your body. Limited evidence suggests it may help people with regurgitation and heartburn, but major studies have not proved a benefit. Ask your doctor whether acupuncture is safe for you.